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Democrats Could Learn From LBJ's Medicare Push

One of the big fears among those crowding town hall meetings this summer is that their coverage under Medicare will be cut back. The debate was just as passionate 45 years ago, when Congress was considering creating Medicare during the Lyndon Johnson administration.

James Morone, co-author of The Heart of Power: Health and Politics in the Oval Office, tell's Renee Montagne that Johnson's Medicare push is "one of the great untold stories."

In his research for the book, Morone listened to phone conversations that Johnson secretly taped in the White House — including a discussion Johnson had with a young senator from Massachusetts: Ted Kennedy.

Renee Montagne: What happened in the middle 1960s — was [Medicare] an idea whose time had come?

James Morone: Several things happened. One thing, the Democratic landslide of 1964, LBJ running against [Barry] Goldwater, and the Democrats swept into office. But a second thing happened, and that's Lyndon Baines Johnson in the White House. He was brilliant at maneuvering Medicare through [Congress], and that's one of the great untold stories. It was a president who was very adept in the White House, who managed to make it happen.

Give us an example of Lyndon Johnson in action.

When Lyndon Johnson is elected, the first thing he decides is he wants Medicare, and he knows he needs Congressman Wilbur Mills (D-AR), chairman of the Ways and Means Committee. Mills has single-handedly fought Medicare and kept it bottled up in his committee. Johnson calls him and tries to get Medicare out of it, and Wilbur says, "I can't, I've been fighting this thing, I'll look like a fool." And Johnson has the idea to triple the size of Medicare, to take the Republican proposals and add them on. And the two of them — these veteran, brilliant legislators — they concoct this whole new proposal that's the administration proposal plus the Republican proposals.

There are tapes of Johnson showing a different side of how he worked [Medicare's passage].

Johnson maneuvered every step of the way getting this bill through Congress, and one of the things he did — and this is a little dicey in today's climate — was suppress the costs. So this young kid gets elected from Massachusetts, Ted Kennedy, in 1962, and Johnson is explaining to him [over the phone] how you get a health bill through. And what he tells him is don't let them get the costs projected too far out because it will scare other people:

"A health program yesterday runs $300 million, but the fools had to go to projecting it down the road five or six years, and when you project it the first year, it runs $900 million. Now I don't know whether I would approve $900 million second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in saying, 'My God, you've got a billion-dollar program for next year on health, therefore I'm against any of it now.' Do you follow me?"

We believe, after looking at the evidence, my co-author [David Blumenthal] and I, that if the true cost of Medicare had been known — if Johnson hadn't basically hidden them — the program would never have passed. America's second-most beloved program would never have happened, if we had had genuine cost estimates.

It isn't as if President Johnson did not have opposition. In fact, he had quite a bit of public opposition, a lot of hand-wringing. One of the most prominent opponents was Ronald Reagan, who was then a candidate for the governor of California:

"One of the traditional methods of imposing statism or socialism on a people, has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project — most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it. Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it."

Socialism, socialized medicine — that is just as scary today for a lot of people as it was in Reagan's time.

If this program passes, Reagan said in another speech, one of these years we will tell our children and our children's children what it was like in America when men were free. What you have to understand, when you hear the town hall meetings, and you hear all the anger today, is that it sounded just the same across the media in 1963, '64, '65 as the Medicare debate heated up. Indeed, Reagan cut his national teeth opposing Medicare and rallying Republicans against it.

What is different now? What are the pitfalls for opponents of the health care overhaul, and what are the pitfalls for the Obama administration that didn't exist in President Johnson's time?

For one thing, the sides won't come together. The Medicare opponents last time voted against it, but when it became inevitable, they all went across the aisle and voted for it. That's not likely to be true this time.

For the Republicans, the great danger is that the program passes and becomes very popular. Democrats spent years and years feasting off Republican opposition to Medicare. There's even a word in Washington: medagogue. A medagogue is someone who demagogues Medicare.

On the Democratic side, what Lyndon Johnson could do is much harder now because the financial situation is so much more complicated. There's an Office of Management and Budget that projects the costs out to the penny way off into the future. There are rules in Congress that say for every penny you spend, you have to find a penny in savings.

All this makes it much more difficult, but even more than all of that, this battle is not just a battle about our health care system, it's a battle — Waterloo, as Sen. James DeMint (R-SC) put it — it's a battle over who is going to control Washington.

If Obama fails, he's deeply injured — much more so than Johnson would have been.

And if he succeeds, why, he succeeded at something that Roosevelt and Truman and Kennedy and Carter and Clinton couldn't do. He's bigger than life.